TIME Heart Disease

This Makes Your Heart Attack Risk 8 Times Higher

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A new study links high levels of anger to an increased risk for heart attack

Getting very angry isn’t just off-putting to the people around you, it may also significantly increase your short-term risk for a heart attack, according to new findings.

Having an episode of intense anger was associated with an 8.5 times greater risk of having a heart attack during the following two hours, a new study published in The European Heart Journal Acute Cardiovascular Care showed. The new findings add to prior research that has suggested high levels of anger may spur a heart attack.

The study looked at 313 people who were being treated in a hospital for a heart attack. The men and women were asked to fill out a questionnaire about the level of anger they experienced in the last 48 hours based on a number scale:

  1. Calm.

  2. Busy, but not hassled.

  3. Mildly angry, irritated and hassled, but it does not show.

  4. Moderately angry, so hassled it shows in your voice.

  5. Very angry, body tense, maybe fists clenched, ready to burst.

  6. Furious, forced to show it physically, almost out of control.

  7. Enraged, out of control, throwing objects, hurting yourself or others.

An anger level greater than five was reported among seven of the people in the study in the two hours prior to their heart attack, and up to four hours prior for one person. An anger level of four was reported among two people within the the two hours before heart attack symptoms, and among four hours before for three people. According to the researchers, the results come to a 8.5-fold increase in relative risk of a heart attack in the two hours following severe anger. People who reported high levels of anxiety, also had a higher risk.

The study is small and therefore it’s still too early to know how great of a factor intense anger is in predicting heart attack onset. The anger levels are also self-reported and could differ person to person. But the study does provide experts with information about what emotional factors could trigger a heart attack. For instance, the researchers found that some of the greatest reported anger was due to arguments with family members followed by arguments with non-family members, work anger and driving anger. “Our findings highlight the need to consider strategies to protect individuals most at risk during times of acute anger,” the authors conclude.

Exactly how anger could trigger a heart attack still remains unknown, but the researchers speculate that the stress may stimulate activity in the heart like increased heart rate and blood pressure, blood vessel constriction, a plaque rupture, and clotting which could eventually lead to a heart attack.

“I think this study is very helpful in many ways because it’s validating to what we already know. Anger is not what we would call a traditional risk factor because it’s so hard to measure,” says Dr. Curtis Rimmerman a cardiologist at the Cleveland Clinic who was not involved in the study. “It highlights the importance of paying attention to a patient’s wellbeing.”

TIME advice

How to Combat Restlessness

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Restlessness isn't necessarily bad, but it could be an important signal from your body or mind

Answer by Mark Schannon on Quora.

First, what is this thing we call restlessness? There is a range of emotional reactions to stimuli that range from pleasure to panic. Somewhere in that long, complex thread exist some reactions that we call restless; they range from mild anxiety, to not be able to sit still, to needing to do something physical or metaphysical (breathing, yoga, meditation) to alleviate the restlessness. What’s interesting is that we all intuitively understand the word, although it may mean something different from a phenomenological point of view to each of us.

Second, whence comes the restlessness? Is there a psychological or physiological cause—or a combination? Restlessness is most often seen as a psychological phenomena. Before going on stage, many actors experience extreme restlessness (e.g. anxiety, fear, stage fright). As a former actor in high school, college, and community productions, I was a nervous wreck before any performance, walking aimlessly, bouncing up and down, generally feeling an almost uncontrollable restlessness. However, the minute I went on stage, that fear, anxiety, restlessness turned into adrenalin which I used to invigorate my role. The same transition occurred numerous times in job interviews, where restlessness (isn’t it a form of anxiety?), which made it almost impossible for me to sit still, was transformed into a positive adrenalin rush when the waiting was over and the interview began.

However, there have been times when my restlessness wasn’t associated with anything concrete; it was a vague, sometimes overpowering sense of discomfort within my own body. Medication, activity, and time usually sufficed to make it go away. Other things mentioned here—meditation et al.—also can work.

But I believe there is a phenomenon that can be called physiological restlessness—you’ve no doubt seen or had yourself the experience of people just shaking their legs up and down, feet on the floor; or walking aimlessly and restlessly. It is sometimes psychological, but it can be attributed to an over-active nervous system, similar to fibromyalgia but without the pain. Medication such as Lyrica, which are not without side effects, can do an amazing job alleviating the feeling of restlessness. It is not anxiety, although it’s very hard to get most doctors to understand the difference; anti-anxiety medication has no effect on it.

Third, “supposed to do” suggests that restlessness is bad and therefore should be eliminated from the various issues going on in your life, as if there’s one and only one solution for anything perceived as a problem. Before you breathe slowly, do meditation, or take drugs, ask yourself the “why” question: What’s going on in your life that could be causing the feelings? Why are you feeling this way? It may be a signal that something wrong is going on. It could also be a signal that you’re like a race horse at the starting gate, anxious to get going. Restlessness isn’t necessarily bad, but it’s almost always (unless is physiological) an important signal from your body.

Good luck!

This question originally appeared on Quora: What am I supposed to do when I feel restless?

More from Quora:

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Mental Health/Psychology

Millennials and Gen Xers Feel the Most Stress About Money

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Even with the improving economy, one population of Americans is more stressed about financial concerns than they were nearly a decade ago

In the latest survey of Stress in America conducted by the American Psychological Association (APA), money remained the top causes of stress reported by a group of more than 3,000 adults aged 18 years or older, followed by work, family and health concerns. Overall, the average level of stress, reported on a 10-point scale, is at its lowest since the APA began the survey in 2007.

But 29% of participants said that their anxiety over money matters increased in the past year, and younger generations and parents seem to be feeling the pinch most. More than one-third of parents reported higher stress levels over the past year (at 5.8) compared to non-parents (at 4.4).

Millennials and Gen Xers (aged 18 to 49 years) felt more stress than the average American about money. “Where Millennials are concerned, we know that the cost of education is pretty high in this country, and student debt is higher,” says Katherine Nordal, executive director of Professional Practice at the APA. “The job market until recently has also been problematic.”

The gap between financial stress between lower and higher income families is also widening; in 2007 both groups reported the same amount of anxiety over money, but in the current survey, those making less than $50,000 a year were twice as likely as those in higher income groups to feel stress about financial matters all or most of the time.

While the overall rate of stress about money is declining, Nordal says the trends involving younger generations and lower income households is concerning, because strategies for coping with stress aren’t improving, despite greater awareness of its health risks. One in five Americans said they did not have anyone to turn to for emotional support; 27% of those in lower income households fall into this category, compared to 17% of those in higher income groups. “Good support systems seem to be good for reducing stress — it’s not an inoculation against stress but it can be a stress reduction factor,” says Nordal.

Lack of emotional support can also drive people to unhealthy coping mechanisms, including over-eating, not sleeping well and becoming more sedentary. Forty-two percent of respondents said they indulged in such behaviors to cope with their stress in the past month. “Excessive alcohol use, smoking, eating the wrong kinds of foods, not exercising and being too sedentary we know are behaviors that lead to disease states, and unhealthy states,” says Nordal. “And these health risks are very real. We’d like to see people doing things that are more proactive to cope with stress, such as meditation, relaxation techniques and exercise.”

TIME advice

How to Not Sweat the Small Stuff

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Learn to use these 4 simple concepts in your everyday life

As a retiring worry wart, there are times I’m faced with minor issues, personal and professional, that seem to drive me crazy, but are really not worth the added stress. I used to destroy myself over every little problem that arose in my life, from completing homework to witnessing unethical behavior to chipping a newly painted nail. But with observation, insight, and honesty, I began to identify what was worth stressing over and what was not. Below are some helpful concepts that I’m learning to use and practice in my everyday life.

1. Think.

Take a moment, breathe, and think again. Think about the issue and what’s causing you more stress. Then think to yourself about how this will really affect your life. Some of the worst decisions come from acting too quickly. Think through the consequences or the possible outcomes of this problem.

2. Question.

How will this event truly affect your life in the long run? I tend to talk to myself in situations like this and ask myself these questions. Saying it verbally out loud makes it more realistic and helps me think through the question and develop approaches and solutions to the problem.

MORE 6 Steps For Handling High Pressure Situations With Grace

3. Remind.

Remind yourself that this isn’t personal and stop acting like it’s the end of the world, because it’s not. Reassure yourself that this too shall pass and there are worse scenarios that could be happening to you; like you could be battling an illness or losing your job. Being stuck behind that school bus on the way to work is not the end of the world.

4. Learn.

Find ways to cope with your stress and learn from this experience. I think I’m a stronger woman today because I learned how to deal with not sweating the small stuff in my collegiate years as a student, sorority president, and part-time worker. I had a lot on my plate and I had to learn how to manage my time and not take everything so personally.

Being able to admit and identify that you worry about too many things is invaluable. Once you identify this, you can use these ideas to resolve it. During my sorority recruitment, I connected with a potential new member (who is now my sorority grandlittle) over our OCD issues. She was experiencing the same things and we could laugh together over our stress. We established a great friendship, and now 6 years later with each of us living on different coasts, we’re still helping one another. It’s easy to talk to someone you know thinks the way you do, and by talking about your issue out loud, you’ll be able to develop a plan to tackle them on your own.

MORE How to Stop Feeling Like You Should be Farther in Life by Now

This article originally appeared on Levo.com.

TIME women

I Am Taking Up Running Again — At 250 Pounds

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What is different about the attempt this time is that I can see my excuses and fears very clearly

xojane

In my dreams, I run without my feet touching the ground.

I’m not quoting a bad motivational poster, that is really how I get around in my dreams — legs churning, hoping no one will notice that I’m sort of levitating.

In reality, it takes a lot of force to shift my inertia from a body at rest to a body in motion. At 250 pounds, I require even more force to get moving than a typical runner. The “typical” runner I imagine is rock-hard and glistening, a lunch-hour runner who makes mortals wonder what breed of insanity motivates her.

I, however, probably make mortals wonder how this body manages to move at a jogging pace at all.

While the need for physical energy to become a runner may be obvious, I require a great deal of mental energy, too. Each day is a battle with my own mind’s powerful attempts to keep me stationary and hidden inside the house. The excuses begin to flow: Is it too hot today? Or maybe it’s going to rain? What if I get a headache? Maybe I will collapse in the street.

In the past, these excuses limited my route to the streets in the direct vicinity of my front yard. I comforted myself by thinking if I had a physical or medical (or emotional) emergency, I would at least be close to home.

Before now, these three fears often kept me from firing my jets:

  1. Fear of judgment: What must people think when they see someone like me bouncing down the sidewalk? Now I just answer, “What people? And who cares?” If anyone is paying attention to me and has mean energy to burn, it can hardly negate the boost I feel from jogging on a nice day with my happy baby rolling along in her stroller ahead of me. (Also, so far, no one has actually said anything mean to me.)
  2. Fear of failure: Running is something I’ve always wanted to be good at, but what if I never am? To fight this fear, I have to define what it means to be good at running. I used to want to be fast. Now I just want to be fast enough. I want to be fast enough to keep up with my (fairly slow) husband. I want to be fast enough to stay in the race, even if I’m dead last.
  3. Fear of pain: What if I end up miles away from home and some part of me really hurts, but I have to retrace those miles to get back? When my confidence to complete a certain distance is low, I have even circled the same few blocks around my house over and over so I could get back quickly in the event of an injury. I don’t know what injury I expected to occur as I shuffled at a near walking pace. The fact is running has never hurt me except for a few headaches due to heat and poor hydration.

As an aspiring runner, I face many more mental challenges than physical ones. Now that I don’t care about speed, and I don’t worry so much about potential injury, I have only one physical challenge to conquer. No, it’s not my weight! My personal challenge is to run farther, longer, and more often, building by tiny increments at a time.

I just started running again in September, as a 39th birthday gift to myself. When I say I started running “again,” you might imagine I was once one of those taut athletic types, and that I’ve only recently found myself in this overweight condition. Not so! I’ve been about this size for at least a decade, and I’ve “started” running at least a handful of times. At my best, I completed a relay half marathon with my husband. At my worst, I dropped out at mile 6 of a half marathon because I was too slow, and they were closing the course behind me. Or you might say the worst moments in my running life were the times I wanted to do it but didn’t have the courage.

I started this time with a fresh short-term goal — to run an entire 5k in March 2015 without walking.

Training Day 1: I insist that my husband run with me to boost my confidence when I try to bail, to help me feel less conspicuous as a very non-runner-looking person, and to distract me as I huff through a minute of running, followed by four minutes of walking.

Day 3: I repeat the one minute running/four minutes walking intervals without my husband-coach. I do, however, rely on my daughter in the jogging stroller to deflect attention from me. I assume people must think I gained a ton of weight while I was pregnant, and now I’m trying to work it off. The truth is I gained only 12 pounds when I was pregnant, and I lost every ounce during birth.

Day 10: OK, I can run two minutes, but can I run another two minutes after catching my breath for four minutes? And then do it again? Turns out I can. I want to say, “Suck it!” to my doubters, a.k.a. myself.

Day 15: Run three minutes, walk three minutes, then run three minutes again? And repeat the whole sequence for a total of 30 minutes? Thank God for riveting podcasts, counting breaths, just getting to the next driveway, the next corner, the next three minutes of walking.

Day 70: After weeks of viruses, travel, cold weather, flat stroller tires, I’m still at the three-minute interval stage. It’s a pace I’ve become submissive to, as the old confidence demon tells me I probably couldn’t last four or more minutes. Each time I stretch the running interval and shorten the walking interval, I drag along that demon. Once I achieve a new goal, I question whether I can repeat it the next day. The only way I can fight my demon is to keep going out and proving him wrong.

What has changed with this most recent attempt at becoming a runner? Not my body — it looks about the same as always, though it does feel stronger and more capable. The difference is that this time I can see my excuses and fears very clearly. Because I recognize them when they try to block my way out the door, it’s easier to slip by them than it was in the past. I used to think they were solid, immovable walls, but now they are paper-thin.

In November the San Antonio Rock ’N’ Roll Marathon and Half-Marathon course passed within a few blocks of my house. We walked over with the baby to watch the runners and walkers at Mile 6, the same point where this race defeated me five years ago. All I could think about this time was signing up again next year.

Anna Lee Beyer is a writer in Texas. This article originally appeared on xoJane.com.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

MONEY Health Care

5 Ways to Save on the Mental-Health Care You Need

Group therapy can be 50% less expensive than one-on-one sessions.

Get the treatment you need at a price you can handle.

Affordable mental-health care has been easier to come by in recent years. Insurance coverage, once riddled with onerous caps and restrictions, is now more widely available. “Things have gotten better for many,” says Andrew Sperling, director of federal advocacy at the National Alliance on Mental Illness.

Still, paying for care can be a challenge. The high out-of-pocket costs that you’re facing for all your health care extend to behavioral coverage too. And low reimbursement rates and billing hassles have led many therapists to not take insurance. A study published last year in the journal JAMA Psychiatry found that only 55% of psychiatrists accept private insurance; for all other medical specialties, that figure is 89%.

Here’s what you need to know about finding the best treatment at the best price.

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MONEY

Insurance Options are Better

Under a 2008 law that took effect in 2010, health plans offered by large employers that include mental-health coverage must treat it like other medical care. So a plan can’t cap annual visits or impose prior authorization rules for behavioral health if it doesn’t do the same for other illnesses, says Jennifer Mathis, director of programs at the Bazelon Center for Mental Health Law. Co-insurance rates have to be the same too. As the graphic above shows, the parity law hasn’t discouraged employers from offering coverage.

Any individual plan you buy on a state insurance exchange must include mental-health coverage; it’s one of the 10 essential benefits required by Obamacare. The provision in the law that lets children stay on a parent’s health plan until age 26 is another boon, since most major psychiatric conditions show up in late adolescence or early adulthood, notes Debbie Plotnick, senior director of state policy at the nonprofit Mental Health America.

Medicare coverage is also better. As of 2014, benefici­aries are responsible for only 20% of mental-health costs, down from 50%.

Your Employer Can Often Help

Especially if you have a high-deductible health plan, start with your company’s employee assistance program, says Kathleen Mahieu, leader of behavioral-health consulting at benefits consultancy Aon Hewitt.

About three-quarters of employers offer an EAP. These programs typically provide five or six sessions of no-cost counseling, even for family members. That’s enough for some people to resolve their issues, says Katherine Nordal, the American Psychological Association’s executive director for professional practice. An EAP can help you find a provider or connect you with other mental-health resources. “It’s a one-stop shop,” says Mahieu. And, she adds, EAPs pride themselves on confidentiality. Your boss won’t know, and you don’t even have to give your name.

Your Bill is Negotiable

When your therapist isn’t in your insurance network, you’ll have to pay upfront and submit the bills for partial payment (assuming you have out-of-network coverage) or, if you’re in an HMO, pay in full. Even if you are reimbursed, you won’t get back, say, 70% of the bill. You’ll get 70% of what the insurer considers “reasonable and customary,” leaving you on the hook for the rest.

If you can’t find an appropriate provider in your plan, ask your insurer to negotiate what’s known as a single-case agreement with someone who’s not in your network, says Barbara Griswold, a licensed marriage and family therapist in San Jose. That would let you to pay the in-network rate.

You can also ask about a reduced fee, says Griswold. “Almost every therapist has a sliding scale,” she says. Be realistic about what you’ll be able to afford and how long you’re likely to want therapy.

You Have Other Ways to Save

A university with a graduate psychology program may have a clinic, says the APA’s Nordal. Care is provided by doctoral trainees who are supervised by licensed psychologists. In an urban area, you may be able to find postgraduate training programs in psychoanalysis or cognitive behavioral therapy for experienced psychologists, says Geoffrey Steinberg, a licensed psychologist in New York City. (Google “training clinic” and the specialty you’re looking for.)

Another option: Ask your therapist if your condition might benefit from group therapy led by an experienced psychologist, which can be 50% less expensive than one-on-one sessions. Says Steinberg, “Group is so underrated and can be so valuable.”

Know Which Treatment Is Best for You

“No single therapy works for everybody,” says Renée Binder of the University of California at San Francisco’s School of Medicine. Consider these approaches for five common conditions.

1. Mild to moderate depression: Go for cognitive behavioral therapy (CBT). “A therapist works with you to break negative thought patterns by teaching specific skills,” says Binder. You might learn, for example, to ID overly critical self-talk (“Everything I do gets screwed up”) and reframe it in a positive way (“I flubbed a presentation, but I know I can rock it next time.”)

2. Severe depression: Combining antidepressants with CBT is better than meds alone, a recent Vanderbilt University study found. You need to see an MD or a psychiatric mental-health nurse practitioner for the prescription, but you can get therapy from a social worker or a psychologist.

3. Social anxiety: Your best bet is either CBT or psycho­dynamic therapy (in which you explore how your past experiences and unconscious affect you). In a study published in July in the American Journal of Psychiatry, these methods were equally effective at easing social anxiety.

4. Panic attacks: CBT is usually the treatment of choice. Some research suggests psychodynamic therapy may also work: A Weill Cornell Medical College study found that 12 weeks of biweekly sessions significantly reduced symptoms in more than 70% of patients. Medications may also be used.

5. Trauma: Look for a therapist who offers trauma-focused CBT or EMDR, which stands for eye movement desensitization and reprocessing (you’re asked to recollect the event while doing a motor task such as side-to-side eye movements). “Antidepressants and anti-anxiety meds are helpful in the short term, but therapy works to change thought patterns long term,” says Binder.

 

TIME Mental Health/Psychology

Here’s How to Make Waiting A Little Less Excruciating

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Some people are better at waiting than others, and there’s a reason for that

We’ve all been there—whether it’s a job interview or an exam or a medical test, once it’s over, there’s nothing we can do but worry and wait.

Some people are better than others at weathering these periods, able to go about their normal lives while only occasionally dwelling on what might happen. The rest of us are nearly paralyzed by the uncertainty, riding waves of hope and despair as we ruminate over every possible outcome.

Kate Sweeny, an associate professor of psychology at University of California Riverside, has made a career out of studying these differences in waiting behaviors. And she’s identified the personality traits that may make distinguish those who are better and worse at waiting—some of which, thankfully, may be adaptable.

In Sweeny’s latest study, published in the Journal of Personality and Social Psychology, she and a colleague studied 50 law school graduates who were waiting for the results of the California bar exam in 2011. The lawyers filled out detailed personality questionnaires that revealed how well they managed uncertainty, whether they were more optimistic or pessimistic, and their self-esteem. She and her colleague also explored how well the lawyers managed their emotions and expectations, and the coping mechanisms they tended to use when they were anxious, among other things.

Not surprisingly, they found that having an optimistic outlook and being more comfortable with uncertainty helped people handle waiting periods better. But they also found that self-esteem did not seem to have much effect on tempering anxiety during the waiting period. In other words, it didn’t matter whether the participants had reported having high self-esteem or not; what mattered more was whether they tended to have a positive outlook and expect the best.

“I was surprised, since plenty of other research suggested that high self-esteem should help people get through difficult periods when their ego is threatened,” says Sweeny.

It also turned out that people’s states during the waiting period were dynamic, changing depending on how close they were to finding out the outcome. At the beginning of the wait, it was harder for all of the participants to distract themselves from thinking about the possible outcomes, and all of them—even the optimists—became more pessimistic or entertained more negative thoughts about the result as they got closer to the moment of truth.

Sweeny and her colleague also learned some interesting things about the coping mechanisms that people use to get through the uncertainty and anxiety of waiting. While distracting yourself with other unrelated tasks or thoughts was a common tactic, it didn’t prove very successful, especially if the participants were trying very hard to consciously distract themselves. “The fact that they are trying so hard to not feel so anxious actually backfires, because it anything it keeps the uncertainty in mind,” she says.

Anticipating bad news and trying to find the positive in it—preparing ahead of time for failure, in other words—may not help to ease the anxiety during the waiting period, but can be helpful once the result comes, since it gives people a sense of control over their future.

And the same is true for distancing your sense of self worth from the outcome. The more space you put between the result and your sense of self, the easier the final outcome may be. “If you convince yourself the bar exam is not that important, and that it’s just a silly exam you have to take and doesn’t reflect on your or your abilities, that space might help you not have a crushing blow to your ego if the news is bad,” she says.

But for all the worriers out there who can’t distract themselves from the anguish of “what if”’ while waiting, there’s also some solace. The study found that those who had a harder time during the waiting period fared better emotionally after the result, regardless of whether it was bad or good. The participants in the study who had more anxiety and frustration while waiting for their bar exam results and ended up failing, for example, were more likely to turn around and start studying for the test again compared to those who didn’t worry as much about the outcome. And if they passed, the relief was sweeter. “There’s a relief when the waiting is over and things turned out well, and you don’t feel as bad if you get bad news,” says Sweeny. “Either way, it’s a little less of a harsh blow if you had a tough waiting period.”

Still, to make that period less painful, she’s currently studying the effects of mindfulness meditation to help those who can’t stop obsessing over the outcome while they wait. The technique, she says, is perfectly designed for managing such waits, since it focuses on helping people to accept their negative emotions but not be driven by them. So while waiting will never be easy, some things in your control, at least, may make it more bearable.

Read next: 5 Signs You Should Take a Break From Social Media

TIME psychology

How to Deal With Anxiety, Tragedy or Heartache — 4 Steps From Research

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“You don’t remember me, but I was in your experiment a year ago. I just wanted to thank you. It changed my life.”

James Pennebaker has had a number of people say this to him over the years.

In the early 80’s he came across a study showing that people who experienced personal traumas but didn’t discuss them were more likely to get sick.

He wondered if just writing about their emotional upheavals could help people recover. And the research he did changed lives.

In the 30 years since, hundreds of studies have documented the effectiveness of expressive writing.

It helped with anxiety, tragedy, heartache… It even gave relief to those coping with cancer, heart disease, chronic pain, and AIDS.

People who write about their problems gain a host of benefits including feeling happier, sleeping better, and even getting better grades.

Via Expressive Writing: Words That Heal:

Across multiple studies, people who engage in expressive writing report feeling happier and less negative than they felt before writing. Similarly, reports of depressive symptoms, rumination, and general anxiety tend to drop in the weeks and months after writing about emotional upheavals (Lepore 1997). Other studies found improvement in overall well-being and improved cognitive functioning (Barclay & Skarlicki 2009).

I wanted to learn more, so I gave the man himself a call.

Jamie Pennebaker is a professor at the University of Texas at Austin and the author of a number of books including:

Expressive Writing: Words That Heal

The Secret Life of Pronouns: What Our Words Say About Us

In this post you’ll learn how writing can help you overcome emotional hardships and the best way to use it to help you get past tough times.

Let’s get started.

Can Just 20 Minutes of Writing Change Your Life?

Bottling up your problems is stressful. People who keep their struggles a secret go to the doctor 40% more often than those who don’t.

Via Expressive Writing: Words That Heal:

…among those who had traumas, those who kept their traumas secret went to physicians almost forty percent more often than those who openly talked about their traumas (Pennebaker & Susman 1988). Later research projects from multiple labs confirmed these results. Adults whose spouses had committed suicide or died suddenly in car accidents were healthier in the year following the death if they talked about the trauma than if they didn’t talk about it… Not talking about important issues in your life poses a significant health risk.

Some of us talk to friends or see a therapist when life gets hard. But not everyone.

It’s risky. Talking about your problems can mean feeling judged. You’re putting yourself on the line when you’re most vulnerable.

But writing lets you get many of the benefits of talking about your problems without the risk.

Here’s Jamie:

…in an ideal world, it works very similar to talking to a friend. The killer problem is when you talk to a friend or even a therapist, you’re putting yourself on the line. For it to work that other person has to be completely accepting, and the reality is we don’t tell our friends a lot of really deep and personal things because we think it might hurt the relationship. That’s the beauty of writing. You don’t have to worry about other people looking down on you or feeling nervous about putting yourself out there.

But what is it about writing that calms the mind and helps us heal emotionally?

There are no solid answers but there’s plenty of research showing the human mind needs meaning — a story to make sense of what has happened.

Only then can it rest. Writing forces you to organize your thoughts into a coherent structure. It helps you make sense of life.

Here’s Jamie:

One thing is that writing helps to organize our experiences…What we find is that people who benefit tend to increase their use of words to suggest thinking. They’re using certain cognitive words. These include causal words like “because,” “cause and effect.” They include insight words: “understand,” “realize” “no” and so forth.

Not only do people who use expressive writing feel better afterward, but that relief has real world benefits.

Those who wrote about the stress of being laid off were more likely to find jobs.

Via Expressive Writing: Words That Heal:

Eight months after writing, fifty-two percent of the emotional writing group had new jobs compared with only twenty percent of the time management participants. The two groups went on the same number of interviews. The only difference was that the expressive writers were offered jobs (Spera, Buhrfeind, & Pennebaker 1994).

(For more on how to overcome regret, click here.)

So writing helps us open up when it doesn’t feel like there’s anyone we can talk to. And it makes sense of the things that shake up our lives.

So what’s the best way to actually do it? There are 4 steps:

1) Ask “How Long Has It Been?”

If you’re upset in the days immediately after a breakup or the death of a loved one, that’s natural.

But when you’re still feeling distressed months later, that’s when you need help and writing can really make a difference.

2) Commit To 20 Minutes For Four Days

Commit to writing about what’s bothering you for 20 minutes on four consecutive days.

This is what the bulk of the research shows provides the best benefits. You can do more if you want; this is a minimum.

Via Expressive Writing: Words That Heal:

What if you want to keep writing after twenty minutes ? Then keep writing. The twenty-minute rule is an arbitrary minimum. That is, plan to write for at least twenty minutes each day with the understanding that you can write more, but you shouldn’t write less… What if you find that you enjoy writing and want to continue past four days? Do it. Many people find that once they begin writing, they realize they have many issues to think about. Write for as many days as you need — just think of the four days as a minimum.

When’s the best time to do it? End of the workday seems to be a good time for many people.

Via Expressive Writing: Words That Heal:

Across multiple studies, we have had the most success with people writing at the end of their workday. If you have children and need to feed them, then after they have gone to bed might be a good time. The operative rule, however, is for you to have some free time after writing to let your mind reflect on what you have written.

(To learn more about what the words you use say about you, click here.)

Got it on your calendar? Good. Here’s what to do.

3) Write Write Write

Just write about what’s bothering you for 20 minutes straight.

Don’t worry about grammar or spelling. Don’t worry about what anyone might think. You can delete it or throw it out when you’re done writing.

Just write about what’s troubling you and don’t hold back.

Here’s Jamie:

Find a place you won’t get disturbed, and I want you to sit down and just begin writing about the thing that’s bothering you. Don’t worry about grammar or sentence structure or spelling. Just write. This is for you and for you alone. Plan to tear up what you’ve done when you finish. It’s not a letter to somebody. It’s not something for you to show someone to convince them that you are right. This is for you alone.

Longhand or typing doesn’t matter. Research even shows talking into a voice recorder works too.

Here’s Jamie:

You can write about the same event on each of the four days or you can write about different events. All that is entirely up to you. Just explore your very deepest thoughts and fears. That’s the basic idea.

(To learn about all the other issues writing can help you with, click here.)

In general, just doing the writing for 20 minutes for four days is enough to provide people with noticeable relief. But let’s go for bonus points.

There are a number of things Jamie has seen that correlate with better results.

4) Stuff That Can Help The Process

When writing, it’s helpful to tie the issue into other areas of your life. How does the problem relate to your work? Your family? Your relationships?

Here’s Jamie:

Let’s say you’re having problems because of a failed love. You may find once you begin writing that it’s related to other topics. You might tie this event to other areas in your life. Your childhood, your relationship with your parents, your relationship with other people… You might tie it to work, you might even link it to who you want to be in the future, who you’ve been in the past and who you are now.

People tend to benefit most from expressive writing if they openly acknowledge emotions.

Via Expressive Writing: Words That Heal:

Emotional experience is part of a trauma. The ability to feel and label both the negative and the positive feelings that occurred during and following the trauma is important.

Constructing a story is powerful.

Via Expressive Writing: Words That Heal:

Creating a narrative, including a coherent beginning, middle, and end, is a well-documented part of trauma treatment and holds much promise for benefits from writing about trauma.

Switch perspectives. Those who benefit the most can see the event through other people’s eyes.

Via Expressive Writing: Words That Heal:

People who have experienced a trauma initially see it from one perspective — their own. Indeed, when individuals first write about a massive upheaval, they first describe what they saw, felt, and experienced. Recent studies indicate that people who benefit the most from writing have been able to see events through others’ eyes.

You’re not writing an accident report for an insurance company. Don’t be distant. Make your writing personal.

Via Expressive Writing: Words That Heal:

A guiding principle of expressive writing is that you express yourself openly and honestly. People who write in a cold, detached manner and who quote Shakespeare, Aristotle, or Henry Ford may be fine historians and may even write a great editorial in the local newspaper. But impressive writing is not the point of expressive writing. People who benefit the most from writing are able to find a voice that reflects who they are.

(To learn more about how to improve your writing skills in general, click here.)

Let’s round up the info and see what Jamie recommends about how to best fit this into our lives.

Sum Up

Here’s how to use writing to overcome the things that upset you:

  1. Has enough time passed? Are you suffering longer than you should? Then writing can help.
  2. Commit to four days of 20 minutes a day. Most people write at the end of their workday.
  3. Write nonstop for 20 minutes about what’s bothering you.Don’t worry about errors or what anyone might think. This is for you.
  4. Tying in other areas of your life, acknowledging emotions, telling a story, switching perspectives and making it personal are all associated with better recovery.

You don’t need to wait until you’re getting divorced or somebody dies to use this. You can write whenever you think it might help. It’s literary ibuprofen.

Via Expressive Writing: Words That Heal:

Think of expressive writing as a tool always be at your disposal, or like having medicine in your medicine cabinet. No need to take the medicine when you are healthy, but when you are under the weather, you can always turn to it.

The science and the numbers are great but I have one more thing to add: I’ve used this myself.

A few months ago someone I cared about deeply betrayed my trust. No apology afterward. No concern for my feelings.

It made it hard for me to trust anyone afterward. I was second-guessing the motives of everyone in my life.

After writing for just 20 minutes it felt like a weight had been lifted off my shoulders. The rage stopped surging up. The rumination died down.

Chaos in your life doesn’t need to mean chaos in your head.

Okay, this blog post is over, folks. So maybe now’s the time to stop reading and start writing.

This piece originally appeared on Barking Up the Wrong Tree.

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MONEY Health Care

The 7 Biggest Health Problems Americans Face—And Who is Profiting

Bottles of prescription medicine in cabinet
Kim Karpeles—Getty Images/age fotostock

Here are the most-prescribed drugs in America.

Americans include two health-related issues among the 10 most important problems facing the U.S., according to a recent Gallup survey. Healthcare in general ranked fourth on the list, with Ebola coming in at no. 8. But is Ebola really among the biggest health problems for Americans? Not when we look at the chances of actually being infected.

So, what are the actual biggest health problems that Americans face? One way to answer this question is to look at what drugs are prescribed the most. Here are the seven top health problems based on the most-prescribed drugs in the U.S., according to Medscape’s analysis of data provided by IMS Health.

1. Hypothyroidism

AbbVie’s ABBVIE INC. ABBV 0.32% Synthroid ranks at the top of the list of most-prescribed drugs. Synthroid is used to treat hypothyroidism, a condition caused by an underactive thyroid gland.

The American Thyroid Association estimates that 2%-3% of Americans have pronounced hypothyroidism, while 10%-15% have a mild version of the disease. Hypothyroidism occurs more frequently in women, especially women over age 60. Around half of Americans with the condition don’t realize that they have hypothyroidism.

2. High cholesterol and high triglycerides

Coming in at a close second on the list is AstraZeneca’s ASTRAZENECA PLC AZN 1.18% Crestor. The drug is used to help control high cholesterol and high triglyceride levels.

According to the American Heart Association, nearly 99 million Americans age 20 and over have high cholesterol. Elevated cholesterol levels are one of the major risk factors for heart attacks and strokes. The problem is that you won’t know if you have high cholesterol unless you get tested — and around one in three Americans haven’t had their cholesterol levels checked in the last five years.

3. Heartburn and gastroesophageal reflux disease

AstraZeneca also claims the third most prescribed drug in the nation — Nexium. The “purple pill” helps treat hearburn and gastroesophageal reflux disease, or GERD, also commonly referred to as acid reflux.

Around 20% of Americans have GERD, according to the American Society for Gastrointestinal Endoscopy. A lot of people take over-the-counter medications, but that’s not enough for many others. Medscape reported that over 18.6 million prescriptions of Nexium were filled between July 2013 and June 2014.

4. Breathing disorders

The next two highly prescribed drugs treat breathing disorders. GlaxoSmithKline’s GLAXOSMITHKLINE PLC GSK -0.14% Ventolin HFA is used by asthma patients, while the company’s Advair Diskus treats asthma and chronic obstructive pulmonary disease, or COPD.

More than 25 million Americans have asthma. Around 7 million of these patients are children. Meanwhile, COPD, which includes chronic bronchitis and emphysema, ranks as the third-leading cause of death in the U.S.

5. High blood pressure

Novartis NOVARTIS AG NVS -0.76% claims the next top-prescribed drug with Diovan. The drug treats high blood pressure by relaxing and widening blood vessels, thereby allowing blood to flow more readily.

Around one-third of American adults have high blood pressure. Many don’t know that they are affected, because the condition doesn’t usually manifest symptoms for a long time. However, high blood pressure can eventually lead to other serious health issues, including heart and kidney problems.

6. Diabetes

Several highly prescribed drugs combat diabetes, with Sanofi’s SANOFI-AVENTIS S.A. SNY 0.02% Lantus Solostar taking the top spot for the condition. Lantus Solostar is a long-acting basal insulin that is used for type 1 and type 2 diabetes mellitus.

According to the National Diabetes Statistics Report released in June 2014, 29.1 million Americans had diabetes in 2012. That’s a big jump from just two years earlier, when 25.8 million Americans had the disease. Diabetes ranks as the seventh leading cause of death in the U.S.

7. Depression and anxiety

Eli Lilly’s ELI LILLY & COMPANY LLY -0.11% Cymbalta fell just below Lantus Solostar in number of prescriptions. Cymbalta is the leading treatment for depression and generalized anxiety disorder.

The Anxiety and Depression Association of America estimates that 14.8 million Americans ages 18 and older suffer from a major depressive disorder each year. Around 3.3 million have persistent depressive disorder, a form of depression that lasts for two or more years. Generalized anxiety disorder affects around 6.8 million adults in the U.S.

Common thread for common diseases

One thing that stands out about several of these common diseases affecting millions of Americans is that many people have one or more of these conditions — but don’t know it. This underscores the importance of getting a checkup on a regular basis.

Regardless of what the Gallup survey found, the odds of you getting Ebola are very low. On the other hand, the chances of you or someone in your family already having one of these seven conditions could be higher than you might think. Perhaps the truly biggest healthcare challenge facing Americans is knowing the status of their own health.

TIME ebola

How to Talk to Your Kids About Ebola

Electron micrograph of Ebola virus
NIAID/EPA

Here's the best way to calm kids' fear and anxiety over Ebola

Even Centers for Disease Control and Prevention director Dr. Tom Frieden admits it: “Ebola is scary.” But for kids seeing alarming headlines without understanding the context of the disease, Ebola can seem like a looming and personal threat.

TIME spoke to Dawn Huebner, a clinical child psychologist and author of the book What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety about the best way to talk about Ebola with your kids—without scaring them silly.

What should I say to my child who is really scared about Ebola?
Let them know that it’s important to think about proximity—how close they themselves are to the virus. Which is to say: not very. “It’s really important to underline that we are safe in the United States, and that people who have contracted Ebola have been in West Africa or were treating patients with Ebola,” says Huebner. “Not only should parents underline how rare Ebola is, and how far away the epidemic is occurring, but also how hard the disease is to contract.” Huebner says parents can tell their older children that direct contact with an infected person’s bodily fluids like vomit or diarrhea is necessary to spread Ebola. “This has been reassuring to the children I see, as they know they are not going to be touching that,” she says.

By ages 7 and up, kids begin to grasp that their worries and fears aren’t always rational. “Parents can talk to kids about how one of the ways worries and anxiety get their power is by making us think about things that are very unlikely,” says Huebner.

Should I keep my child away from the news?
Your kids can watch the news to stay informed, but media overload is not always a good thing. “The news is often sensationalized and gives kids the idea that they are at an imminent risk,” says Huebner. When kids see endless stories about Ebola on the news, they don’t always realize they’re hearing the same thing on loop. “I’ve had kids come into my office who are under the impression that there are hundreds of people in the U.S. with Ebola.”

How do I know if my child is reacting appropriately to the news?
“An appropriate reaction would be to feel nervous and ask some questions, but to be reassured by the parents’ answers,” says Huebner. Psychologists distinguish between questions that are information-gathering, and questions that are reassurance-seeking. If a child asks reassurance-seeking questions—like “Are we going to be ok?”—once or twice, that’s normal. But asking the same questions over and over signifies that a child is really dealing with anxiety and that their concern is not being curbed. At that point, parents may need to sit their children down for a longer conversation to address their fears and concerns.

My kids don’t want to fly on an airplane over the holidays. How do I convince them they are safe?
It’s important to emphasize that the vacation destination is one that is safe, and not at great risk for Ebola. Parents can also stress that no one in the United States has yet contracted Ebola from a plane ride. However, parents should avoid making comparisons, like “It’s more likely to get in a car crash than to get Ebola.” That will only stress a child out more.

Ebola freaks me out too, and I accidentally overreacted in front of my child. How do I fix this?
“One of the wonderful things about children is that you really can revisit things that didn’t go so well the first time,” says Huebner. If parents slip up with an overreaction, they should have a conversation with their children and reference the moment. She suggests a conversation opener like this one: “I was thinking about when you overheard me on the phone with my friend. I was really overreacting. I got nervous when I heard about Ebola, and you saw me when I was nervous. Now I’ve gotten information and I’ve calmed down, and I’ve realized this is a very sad thing that’s happening far away. It’s sad, but it doesn’t have to be scary for us.” Rational, calm conversations will help ease a child’s fears about Ebola.

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